Activity Hazard Analysis-Blank Work Sheet.docx
DOCX document 37 KB Posted
- Solicitation number
- 19KE5025Q0087
- Issued by
-
Department of State
About this file
The document is an Activity Hazard Analysis (AHA) worksheet template designed to assess safety risks for job tasks. The template provides a structured method for evaluating potential hazards by using a Risk Assessment Code (RAC) matrix that considers both the probability of an incident (ranging from Frequent to Unlikely) and the severity of potential outcomes (from Catastrophic to Negligible). The worksheet includes sections for documenting job steps, specific hazards, control measures, equipment usage, training requirements, and inspection criteria, enabling systematic risk identification and mitigation planning.
The related federal contract opportunity is a U.S. Department of State solicitation (19KE5025Q0087) for preventive maintenance services at the Waste Water Treatment Plant (WWTP) for the U.S. Embassy in Nairobi, Kenya. The solicitation requires the contractor to provide personnel, supplies, and equipment for maintaining wastewater treatment systems, with the specific goal of ensuring proper operation and maintenance of the embassy's wastewater infrastructure.
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Other files
| File | Type | Posted |
|---|---|---|
| SS-Maint_UCF WWTP v1.pdf | ||
| AHA Sample Scaffolding.doc | DOC document | |
| Risk Matrix.doc | DOC document |
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Text version
Activity Hazard Analysis (AHA)
| Activity/Work Task: |
| Overall Risk Assessment Code (RAC) (Use highest code) |
| Project Location: |
| Risk Assessment Code (RAC) Matrix |
| Contract Number: |
| Severity |
| Probability |
Date Prepared:
| Frequent |
| Likely |
| Occasional |
| Seldom |
| Unlikely |
| Prepared by (Name/Title): |
| Catastrophic |
| E |
| E |
| H |
| H |
| M |
| Critical |
| E |
| H |
| H |
| M |
| L |
| Reviewed by (Name/Title): |
| Marginal |
| H |
| M |
| M |
| L |
| L |
| Negligible |
| M |
| L |
| L |
| L |
| L |
| Notes: (Field Notes, Review Comments, etc.) |
| Step 1: Review each “Hazard” with identified safety “Controls” and determine RAC (See above) |
| “Probability” is the likelihood to cause an incident, near miss, or accident and identified as: Frequent, Likely, Occasional, Seldom or Unlikely. |
| RAC Chart |
| “Severity” is the outcome/degree if an incident, near miss, or accident did occur and identified as: Catastrophic, Critical, Marginal, or Negligible |
| E = Extremely High Risk |
H = High Risk
| Step 2: Identify the RAC (Probability/Severity) as E, H, M, or L for each “Hazard” on AHA. Annotate the overall highest RAC at the top of AHA. |
| M = Moderate Risk |
L = Low Risk
| Job Steps |
| Hazards |
| Controls |
| RAC |
| Equipment to be Used |
| Training Requirements/Competent or Qualified Personnel name(s) |
| Inspection Requirements |
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